BCR-ABL阴性骨髓增殖性肿瘤患者右心功能损伤评估指标的临床意义  

Clinical significances of evaluation indexes of right heart function injury in patients with BCR-ABL-negative myeloproliferative neoplasms

作　　者：柴星星[1] 杜晓鹏 方向标 庄万传[1] 刘晓庆 何耀[1] 何广胜[2] 李建勇[2] Chai Xingxing;Du Xiaopeng;Fang Xiangbiao;Zhuang Wanchuan;Liu Xiaoqing;He Yao;He Guangsheng;Li Jianyong(Department of Hematology,the Second People's Hospital of Lianyungang,Lianyungang 222000,China;Department of Hematology,the First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital,Nanjing 210029,China)

机构地区：[1]连云港市第二人民医院血液科,连云港222000 [2]南京医科大学第一附属医院江苏省人民医院血液科,南京210029

出　　处：《白血病．淋巴瘤》2023年第12期736-739,共4页Journal of Leukemia & Lymphoma

基　　金：国家中医药管理局行业专项(201407001-4);卫生部科研基金(201202017);江苏省医学重点项目(BL2014086);江苏省普通高校优势学科(JX10231801);连云港市卫生健康委员会项目(202119)。

摘　　要：目的探讨BCR-ABL阴性骨髓增殖性肿瘤(MPN)患者右心功能损伤评估指标的临床意义。方法回顾性分析2015年1月至2021年8月连云港市第二人民医院及江苏省人民医院诊断的208例BCR-ABL阴性MPN患者的临床资料,其中原发性骨髓纤维化(PMF)63例、真性红细胞增多症(PV)39例、原发性血小板增多症(ET)106例,比较3组患者临床特征及血液学相关指标检查结果,并对右心功能损伤相关指标检查结果进行分析,包括超声心动图、脑利钠肽、可溶性生长刺激表达基因2蛋白(sST-2)、乳酸脱氢酶(LDH)、D-二聚体、铁蛋白、β2-微球蛋白、外周血WT1基因、CD34+细胞计数等。结果208例患者中,男性109例,女性99例,中位年龄62岁(23岁,89岁)。PMF、PV、ET患者血红蛋白、血小板计数、D-二聚体、LDH、铁蛋白水平比较,差异均有统计学意义(均P<0.05)。87例患者行心脏彩色超声检查,其中PMF 26例、PV 19例、ET 42例;肺动脉压增高69例(79.3%),左心房直径增大76例(87.3%),右心室舒张期内径增大59例(67.8%);PMF、PV、ET患者肺动脉压、左心房直径、右心室舒张期内径差异均有统计学意义(均P<0.05)。Pearson相关分析结果显示,患者肺动脉压与铁蛋白、LDH、sST-2、年龄均呈正相关(r值分别为0.796、0.768、0.915、0.734,均P<0.05),与血小板计数呈负相关(r=-2.330,P=0.034)。结论对于BCR-ABL阴性MPN患者,肺动脉压、铁蛋白、LDH的升高及血小板计数、血红蛋白的降低可能使右心功能受损概率增大;铁蛋白、LDH、sST-2、年龄越高及血小板计数越低,肺动脉压可能越高。Objective To investigate the clinical significances of evaluation indexes of right heart function injury in patients with BCR-ABL-negative myroproliferative neoplasms(MPN).Methods The clinical data of 208 patients with BCR-ABL-negative MPN diagnosed in the Second People's Hospital of Lianyungang and Jiangsu Province Hospital from January 2015 to August 2021 were retrospectively analyzed,including 63 cases of primary myelopathic fibrosis(PMF),39 cases of polycytosis vera(PV)and 106 cases of essential thrombocythemia(ET).The clinical characteristics of patients and the examination results of hematological related indicators were compared among the three groups.The examination results of indexes of right heart function injury were analyzed,including echocardiography,brain natriuretic peptide,soluble growth stimulation expression gene-2(sST-2),lactate dehydrogenase(LDH),D-dimer,ferritin,β2-microglobulin,peripheral blood WT1 gene,CD34+cell count,etc.Results Of the 208 patients,109 were male and 99 were female;the median age was 62 years old(23 years old,89 years old).The differences in levels of hemoglobin,platelet count,D-dimer,LDH and ferritin among PMF,PV and ET patients were statistically significant(all P<0.05).Color echocardiography was performed in 87 patients,including 26 cases of PMF,19 cases of PV and 42 cases of ET.Pulmonary artery pressure increased in 69 cases(79.3%),left atrial diameter increased in 76 cases(87.3%),and diameter increased during right ventricular diastolic period in 59 cases(67.8%).There were significant differences in pulmonary artery pressure,left atrial diameter and diameter during right ventricular diastolic period among PMF,PV and ET patients(all P<0.05).Pearson correlation analysis showed that pulmonary artery pressure was positively correlated with ferritin,LDH,sST-2 and age(r values were 0.796,0.768,0.915 and 0.734,all P<0.05),while it was negatively correlated with platelet count(r=-2.330,P=0.034).Conclusions For BCR-ABL-negative MPN patients,the increase of pulmonary artery pre

关 键 词：骨髓增殖性肿瘤 右心功能损伤 肺动脉压 D-二聚体 

分 类 号：R733.3[医药卫生—肿瘤]